Evolving discourses of COVID-19 and implications for medical education: a critical discourse analysis





Background: The othering of individuals has been identified as a concern during the COVID-19 pandemic. The purpose of this study was to examine public commentary during early stages of the pandemic for: 1) emerging discourses that highlighted population-level inequities, and 2) the implications these discourses may have for medical education.

Methods: Using a critical discourse analysis (CDA) approach, an archive of texts available in the public domain discussing COVID-19 was iteratively created, reviewed, and coded. We used an intersectional framework to analyze how COVID-19 highlighted structural and institutional inequity at the population level.

Results: We found 86 representative texts published from March to June 2020. We focused our analysis on implications within Ontario. The two major discourses that emerged were “COVID-19 as Equalizer” and “COVID-19 as Discriminator.” The former emerged in the early stages of the pandemic to mobilize public health recommendations and describe near-universal impacts on the public. The latter followed to highlight new and pre-existing forms of marginalization exacerbated by the pandemic.

Conclusions: This study provides a unique perspective on how structural and systemic responses to COVID-19 were shaped through analysis of public discourse, and therefore, has implications for how the COVID-19 pandemic and future pandemics are framed for future medical learners.


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World Health Organization. Rolling updates on coronavirus disease (COVID-19). 31 Jul 2020 Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen. [Accessed on Aug 1, 2020].

Powell M. What role can the media play in managing the COVID-19 outbreak? [Internet]. Infectious Diseases Hub. 2020. Available from: https://www.id-hub.com/2020/03/05/role-can-media-play-managing-covid-19-outbreak. [Accessed on Mar 23, 2020].

Government of Canada. Coronavirus disease (COVID-19): prevention and risks. [Internet]. 2020. Available from: https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/prevention-risks.html?topic=tilelink. [Accessed on Jun 9, 2020].

Davis M, Flowers P, Stephenson N. “We had to do what we thought was right at the time”: retrospective discourse on the 2009 H1N1 pandemic in the UK. Sociology of Health & Illness. 2014;36(3):369-382. https://doi.org/10.1111/1467-9566.12056

Wenham K, Harris N, Sebar B. Reflections of inequalities: the construction of HIV/AIDS in Africa in the Australian print media. Health Sociology Review. 2009;18(3):284–296.

Nieblas-Bedolla E, Christophers B, Nkinsi NT, Schumann PD, Stein E. Changing how race is portrayed in medical education: recommendations from medical students. Acad Med. 2020;95(12): 1802-1806. https://doi.org/10.1097/ACM.0000000000003496

Association of Faculties of Medicine of Canada. The future of medical education in Canada (FMEC): a collective vision for MD education 2010-2015. AFMC. [Internet]. 2015. Available from: https://www.afmc.ca/sites/default/files/pdf/2015-FMEC-MD_EN.pdf.[Accessed on May 1, 2020].

Association of American Medical Colleges. Diversity in medicine: Facts and figures. AAMC. [Internet]. 2019. Available from: https://www.aamc.org/data-reports/workforce/interactive-data/fostering-diversity-and-inclusion. [Accessed on May 1, 2020].

Tsai J, Ucik L, Baldwin N, Hasslinger C, George P. Race matters? Examining and rethinking race portrayal in preclinical medical education. Acad Med. 2016;91(7):916–920. https://doi.org/10.1097/ACM.0000000000001232

Krishnan A, Rabinowitz M, Ziminsky A, Scott SM, Chretien KC. Addressing race, culture, and structural inequality in medical education: a guide for revising teaching cases. Acad Med. 2019;94(4):550–555. https://doi.org/10.1097/ACM.0000000000002589

Young T. COVID 19: the drive for equity. University of Toronto, Faculty of Medicine. [Internet]. 2020. Available from: https://temertymedicine.utoronto.ca/news/covid-19-drive-equity. [Accessed on Jan 28, 2022].

Tyler IV, Hau M, Buxton J, et al. Canadian medical students’ perceptions of public health education in the undergraduate medical curriculum. Acad Med. 2009 Sep; 84(9): 1307-1312.

Mason KA. H1N1 is not a Chinese virus: the racialization of people and viruses in post-SARS China. St Comp Int Dev. 2015;50:500-518. https://doi.org/10.1007/s12116-015-9198-y

Person B, Sy B, Holton K, Govert B, Liang A, NCID/SARS community outreach team. fear and stigma: the epidemic within the SARS outbreak. Emerg Infect Dis. 2004;10(2):358-363. https://doi.org/10.3201/eid1002.030750

McCauley M, Minsky S, Viswanath K. The H1N1 pandemic: media frames, stigmatization and coping. BMC Public Health. 2013;13:1116. https://doi.org/10.1186/1471-2458-13-1116

Chesney MA, Smith AW. Critical delays in HIV testing and care: The potential role of stigma. Am Behav Sci. 1999;42:1162-1174. https://doi.org/10.1177/00027649921954822

Roberts MLA, Schiavenato M. Othering in the nursing context: a concept analysis. Nurs Open. 2017; 4(3): 174-181

Carney JK, Schilling LM, Frank SH, et al. Planning and incorporating public health preparedness into the medical curriculum. Am J Prev Med. 2011;41(4S3):S193–S199.

Maeshiro R, Carney JK. Public health is essential: COVID-19’s learnable moment for medical education. Acad Med. 2020; 95(12): 1799-1801. https://doi.org/10.1097/ACM.0000000000003517

Machado S, Goldenberg S. Sharpening our public health lens: advancing im/migrant health equity during COVID-19 and beyond. Int J Equity. 2021; 57. https://doi.org/10.1186/s12939-021-01399-1.

Shah NN, Maheshwary RR, Ovruchesky E, Jain S. Americaan medical education must focus on health inequities. Clin Teach. 2021 Feb; 18(1): 82-83. https://doi.org/10.1111/tct.13259.

Kuper A, Veinot P, Leavitt J, Levitt S, Li A, Goguen J, Schreiber M, Richardson L, Whitehead CR. Epistemology, culture, justice and power: non-bioscientific knowledge for medical training. Med Educ. 2017 Feb; 51(2): 158-173. https://doi.org/10.1111/medu.13115.

The Association of Faculties of Medicine Canada. COVID-19. Available from: https://afmc.ca/en/priorities/covid19. [Accessed on Sep 19, 2020].

Underwood N. Medical schools pivot to prepare and protect students for front-line work. The Globe and Mail [Internet]. 2020 Sept 16. Available from: https://www.theglobeandmail.com/featured-reports/article-medical-schools-pivot-to-prepare-and-protect-students-for-front-line/. [Accessed on Sep 19, 2020].

Skylar DP. COVID-19: Lessons from the disaster that can improve health professions education. Acad Med. 2020;95(11): 1631-1633. https://doi.org/10.1097/ACM.0000000000003547

Rose S. Medical student education in the time of COVID-19. JAMA. 2020;323(21): 2131-32.

Fairclough, Norman, Ruth Wodak. Critical discourse analysis. In T. A. van Dijk, ed., Discourse as social interaction: discourse studies: a multidisciplinary introduction, vol. 2. 1997. Thousand Oaks, CA: Sage, pp. 258– 84.

Kuper A, Whitehead C, Hodges BD. Looking back to move forward: using history, discourse and text in medical education research: AAME guide no. 73. Med Teach. 2013;35:e849-e860. https://doi.org/10.3109/0142159X.2012.748887

Foucault, M. 2006a. The Archaeology of Knowledge (Translated by S. Smith). London: Routledge.

Hodges BD, Martimianakis MA, McNaughton N, Whitehead C. Medical education…Meet Michel Foucault. Med Educ. 2014;48:563-571. https://doi.org/10.1111/medu.1241124

Foucault (M.). The order of discourse. in: Shapiro (M.), (ed.). The politics of language. 1984. Oxford : Blackwell.

Crenshaw A. Demarginalizing the intersection between race and sex: a Black feminist critique of antidiscimination doctrine, feminist theory, and anti-racist politics. University of Chicago Legal Forum. 1989. pp 139-167.

Zimmermann C. Denial of impending death: a discourse analysis of the palliative care literature. Soc Sci Med. 2004;59:1769–1780.

Annandale E, Hammarström A. Constructing the ‘gender-specific body’: a critical discourse analysis of publications in the field of gender-specific medicine. Health (London). 2011;15:571–587.

Kako PM, Dubrosky R. “You comfort yourself and believe in yourself”: exploring lived experiences of stigma in HIV-positive Kenyan women. Issues Ment Health Nurs. 2013;34:150-157. https://doi.org/10.3109/01612840.2012.74076

Eichelberger L. SARS and New York’s Chinatown: The politics of risk and blame during an epidemic of fear. Soc Sci Med. 2007;65:1284-1295. https://doi.org/10.1016/j.socscimed.2007.04.022

Capatides C. CNN anchor Chris Cuomo says he tested positive for coronavirus [Internet]. CBS News. 31 Mar 2020. Available from: https://www.cbsnews.com/news/chris-cuomo-coronavirus-tests-positive-covid-19/. [Accessed on May 5, 2020].

Higgins-Dunn N, Mangan D, Lovelace B, Feuer W. The coronavirus outbreak is a ‘real threat to everyone on the planet,’ WHO official says. [Internet]. CBNC. 1 Apr 2020. Available from: https://www.cnbc.com/2020/04/01/global-coronavirus-cases-will-hit-1-million-and-50000-deaths-in-a-few-days-who-officials-say.html. [Accessed on May 5, 2020].

Goldenberg S, Eisenberg A, Muoio D. ‘Everybody’s in the same boat’: Coronavirus drives New York’s hospitals to breaking point. [Internet]. Politico. 31 Mar 2020. Available from: https://www.politico.com/states/new-york/albany/story/2020/03/31/everybodys-in-the-same-boat-coronavirus-drives-new-yorks-hospitals-to-breaking-point-1269943. [Accessed on May 5, 2020].

Cadesky E. Coronavirus and cognitive bias: the surprising reasons people cheat at social distancing. [Internet]. 20 May 2020. Toronto Star. Available from: https://www.thestar.com/opinion/contributors/2020/05/20/coronavirus-and-cognitive-bias-the-surprising-reasons-people-cheat-at-social-distancing.html. [Accessed on May 20, 2020].

Bensadoun E. Canada will use ‘every measure in our toolbox’ to prevent COVID-19 spread, minister says. [Internet]. Global News. 22 Mar 2020. Available from: https://globalnews.ca/news/6715135/coronavirus-social-distancing-punishments-canada/. [Accessed on Jun 22, 2020].

The Canadian Press. Officials say efforts by Canadians to flatten the curve of COVID-19 are working. [Internet]. 2 May 2020. CityTV. Available from: https://www.ctvnews.ca/politics/officials-say-efforts-by-canadians-to-flatten-the-curve-of-covid-19-are-working-1.4922015. [Accessed on Aug 21, 2020].

Boyd A. Race-based coronavirus data not needed in Canada yet, health officials say. [Internet]. 11 Apr 2020. Toronto Star. Available from: https://www.thestar.com/news/canada/2020/04/10/race-based-coronavirus-data-not-needed-in-canada-yet-health-officials-say.html. [Accessed on May 5, 2020].

Anderssen E. Even when COVID-19 is beaten, the stress and depression of the pandemic will still be with us. How do we recover? [Internet]. 11 May 2020 [Accessed on 26 June 2020]. Globe and Mail. Available from: https://www.theglobeandmail.com/canada/article-even-when-covid-19-is-beaten-the-stress-and-depression-of-the/

Department of Finance. Government introduces Canada Emergency Response Benefit to help workers and businesses. [Internet]. 25 Mar 2020. Government of Canada. Available from: https://www.canada.ca/en/department-finance/news/2020/03/introduces-canada-emergency-response-benefit-to-help-workers-and-businesses.html. [Accessed on Sep 1, 2020].

Health Canada. Government of Canada connects Canadians with mental wellness supports during COVID-19. [Internet]. 15 Apr 2020. Government of Canada. Available from: https://www.canada.ca/en/health-canada/news/2020/04/government-of-canada-connects-canadians-with-mental-wellness-supports-during-covid-190.html. [Accessed on Sep 1, 2020].

Ibbitson J, Parkinson D. CERB and other coronavirus benefits won’t last forever. Or will they? What a universal basic income could look like. [Internet]. 15 May 2020. Globe and Mail. Available from: https://www.theglobeandmail.com/opinion/article-cerb-and-other-coronavirus-benefits-wont-last-forever-or-will-they/. [Accessed on May 20, 2020].

Laupacis A. Feeling pessimistic about COVID-related inequities. [Internet]. CMAJ Blogs. 13 Apr 2020. Available from: https://cmajblogs.com/feeling-pessimistic-about-covid-revealed-inequities/. [Accessed on May 5, 2020].

Wittenberg JV, Waitzer E. The pandemic is increasing the gap between the haves and have nots. Globe and Mail. [Internet]. 19 May 2020. Available from: https://www.theglobeandmail.com/opinion/article-the-pandemic-is-increasing-the-gap-between-the-haves-and-have-nots/. [Accessed on May 20, 2020].

Alliance for Healthier Communities. Statement from Black health leaders on COVID-19’s impact on Black communities in Ontario. [Internet]. Alliance for Healthier Communities. 2 Apr 2020. Available from: https://www.allianceon.org/news/Statement-Black-Health-Leaders-COVID-19s-impact-Black-Communities-Ontario. [Accessed on Jun 24, 2020].

Hansen N. Who gets medical care during the coronavirus pandemic — and what does that mean for people with disabilities? [Internet]. CBC. 5 Apr 2020. Available from: https://www.cbc.ca/news/canada/manitoba/manitobans-disability-health-care-coronavirus-1.5520589. [Accessed on Jun 27, 2020].

Bellegarde P. The COVID-19 crisis on First Nations: a reminder of our inequality and an opportunity for change. [Internet]. Globe and Mail. 6 Apr 2020. Available from: https://www.theglobeandmail.com/opinion/article-the-covid-19-crisis-on-first-nations-a-reminder-of-our-inequality-and/. [Accessed on Jun 27, 2020].

Mendleson R. Vulnerable First Nations brace for COVID-19’s spread. [Internet]. Toronto Star. 10 Apr 2020. Available from: https://www.thestar.com/news/canada/2020/04/09/vulnerable-first-nations-brace-for-covid-19s-spread.html. [Accessed on Jun 26, 2020].

Boyd A. Race-based coronavirus data not needed in Canada yet, health officials say. [Internet]. 11 Apr 2020. Toronto Star. Available from: https://www.thestar.com/news/canada/2020/04/10/race-based-coronavirus-data-not-needed-in-canada-yet-health-officials-say.html. [Accessed on May 5, 2020].

Nnorom O. Systemic anti-Black racism is a problem in Canada, as recognized by the United Nations: “Canada’s history of enslavement, racial segregation, and marginalization, has had a deleterious impact on people of African descent which must be addressed in partnership with communities. [Internet]. 11 Apr 2020. Available from: https://twitter.com/OnyeActiveMD/status/1248987952761446403. [Accessed on May 5, 2020].

Chotiner I. The interwoven threads of inequality and health. [Internet]. New Yorker. 14 Apr 2020. Available from: https://www.newyorker.com/news/q-and-a/the-coronavirus-and-the-interwoven-threads-of-inequality-and-health. [Accessed on May 5, 2020].

Yancy CW. COVID-19 and African Americans. JAMA. 2020;323(19): 1891-92. https://doi.org/10.1001/JAMA.2020.6548

Zarroli J. The rich really are different. They can shelter in nicer places. [Internet]. NPR. 15 Apr 2020. Available from: https://www.npr.org/2020/04/15/834247954/the-rich-really-are-different-they-can-shelter-in-nicer-places. [Accessed on May 5, 2020].

Flanagan R. Does COVID-19 discriminate? This is how some Canadians are harder-hit. [Internet]. CTV News. 15 Apr 2020. Available from: https://www.ctvnews.ca/health/coronavirus/does-covid-19-discriminate-this-is-how-some-canadians-are-harder-hit-1.4897298. [Accessed on Jun 30, 2020].

Bain B, Dryden O, Walcott R. Coronavirus discriminates against Black lives through surveillance, policing and the absence of health data. [Internet]. The Conversation. 20 Apr 2020. Available from: https://theconversation.com/coronavirus-discriminates-against-black-lives-through-surveillance-policing-and-the-absence-of-health-data-135906?utm_source=twitter&utm_medium=bylinetwitterbutton. [Accessed on May 5, 2020].

Mojtehedzadeh S. Toronto public health to start collecting COVID-19 data on race in a bid to track health inequities. Toronto Star. 21 Apr 2020. Available from: https://www.thestar.com/news/gta/2020/04/21/toronto-public-health-to-start-collecting-covid-19-data-on-race-in-a-bid-to-track-health-inequities.html. [Accessed on May 5, 2020].

Canadian Public Health Association. CPHA calls for culturally safe collection and use of socio-demographic and race-based data. Canadian Public Health Association. [Internet]. 15 May 2020. Available from: https://www.cpha.ca/cpha-calls-culturally-safe-collection-and-use-socio-demographic-and-race-based-data. [Accessed on May 20, 2020].

Star Editorial Board. Failure in long-term care was tragically predictable. Toronto Star. [Internet]. 5 May 2020. Available from: https://www.thestar.com/opinion/editorials/2020/05/05/failure-in-long-term-care-was-tragically-predictable.html. [Accessed on May 20, 2020].

McKenzie K. COVID-19: remembering the forgotten. Wellesley Institute. [Internet]. 6 May 2020. Available from: https://www.wellesleyinstitute.com/healthy-communities/remembering-the-forgotten/. [Accessed on May 20, 2020].

CBC News. Lower income people, new immigrants at higher COVID-19 risk in Toronto, data suggests. CBC. [Internet]. 12 May 2020. Available from: https://www.cbc.ca/news/canada/toronto/low-income-immigrants-covid-19-infection-1.5566384?__vfz=medium%3Dsharebar. [Accessed on May 20, 2020].

The Editorial Board. Canada’s pandemic record is good, but we failed when it came to protecting seniors homes. Globe and Mail. [Internet]. 10 May 2020. Available from: https://www.theglobeandmail.com/opinion/editorials/article-canadas-pandemic-record-is-good-but-we-failed-when-it-came-to/. [Accessed on May 20, 2020].

Teitel E. We screwed up, Toronto. Trinity Bellwoods Park looked more like a scene out of Coachella ‘19 than life under COVID-19. Toronto Star. [Internet]. 25 May 2020. Available from: https://www.thestar.com/opinion/star-columnists/2020/05/25/we-screwed-up-toronto-trinity-bellwoods-park-looked-more-like-a-scene-out-of-coachella-19-than-life-under-covid-19.html. [Accessed on Aug 1, 2020].

Macdonald D. COVID-19 and the Canadian workforce. [document on the internet]. Ottawa, Canada; 2020. Available from: https://www.policyalternatives.ca/publications/reports/covid-19-and-canadian-workforce. [Accessed May 1, 2020].

Mojtehedzadeh S. Their work is keeping Canada safe. But they earn a fraction of the national average. [Internet]. Toronto Star. 31 Mar 2020. Available from: https://www.thestar.com/business/2020/03/31/these-workers-are-keeping-canada-safe-but-they-earn-a-fraction-of-the-national-average.html. [Accessed on Aug 1, 2020].

Gillis W. Forced to stay home with their abusers, Canadian victims of domestic violence must ‘choose between two pandemics’ [Internet]. Toronto Star. 20 Apr 2020. Available from: https://www.thestar.com/news/canada/2020/04/20/forced-to-stay-home-with-their-abusers-canadian-victims-of-domestic-violence-must-choose-between-two-pandemics.html. [Accessed on Jun 26, 2020].

Wright T. Violence against Indigenous women during COVID-19 sparks calls for MMIWG plan. Toronto Star. [Internet]. 10 May 2020. Available from: https://www.thestar.com/news/canada/2020/05/10/violence-against-indigenous-women-during-covid-19-sparks-calls-for-mmiwg-plan.html. [Accessed on Jun 26, 2020].

Werner RM, Hoffman AK, Coe NB. Long-Term Care Policy after Covid-19 — Solving the Nursing Home Crisis. New Eng J Med. 2020;383(10): 903–5.

Government of Ontario. Long-Term Care COVID-19 Commission. [Internet]. 25 May 2021. Available from: https://www.ontario.ca/page/long-term-care-covid-19-commission. [Accessed on May 26, 2021].

Howlett K. Ontario long-term care homes weren’t prepared for COVID-19 pandemic, auditor-general says. Globe and Mail. [Internet]. 28 Apr 2021. Available from: https://www.theglobeandmail.com/canada/article-ontario-long-term-care-homes-werent-prepared-for-covid-19-pandemic/. [Accessed on May 26, 2021].

Lilley B. COVIDIOTS: Trinity Bellwoods jam-packed despite rules. Toronto Sun [Internet]. 24 May 2020. Available from:

https://torontosun.com/news/local-news/covidiots-trinity-bellwoods-jam-packed-despite-rules. [Accessed on Sept 19, 2020].

Kirkup K. Ottawa eyes COVID-19 vaccine rollout to Indigenous communities. Globe and Mail [Internet]. 16 Dec 2020. Available from: https://www.theglobeandmail.com/politics/article-ottawa-eyes-covid-19-vaccine-rollout-to-indigenous-communities/. [Accessed on May 26, 2021].

Alhmidi M. Racialized adults should be prioritized for COVID-19 vaccination, new guidance suggests. Globe and Mail [Internet]. 16 Feb 2021. Available from: https://www.theglobeandmail.com/canada/article-racialized-adults-on-revised-federal-covid-19-vaccination-priority-2/. [Accessed on May 26, 2021].

Grant K, Keller J, Perreaux L. Warming up to the hotspot strategy: Why targeting hard-hit areas for immunization is Canada’s best shot at reducing COVID-19 cases. Globe and Mail [Internet]. 24 Apr 2021. Available from: https://www.theglobeandmail.com/canada/article-warming-up-to-the-hotspot-strategy-why-targeting-hard-hit-areas-for/. [Accessed on May 26, 2021].

Dhillon J, Salimi A, ElHawary H. Impact of COVID-19 on Canadian medical education: pre-clerkship and clerkship students affected differently. J Med Ed Curr Dev. 2020; 7: 1-5. https://doi.org/10.1177/2382120520965247.

Toronto Public Health. COVID-19: Pop-Up Immunization Clinics. Available from: https://www.toronto.ca/home/covid-19/covid-19-vaccines/covid-19-how-to-get-vaccinated/covid-19-pop-up-immunization-clinics/. [Accessed on 29 Jan 2022].

Underwood N. Medical schools pivot to prepare and protect students for front-line work. Globe and Mail [Internet]. 17 Sep 2020. Available from: https://www.theglobeandmail.com/featured-reports/article-medical-schools-pivot-to-prepare-and-protect-students-for-front-line/?fbclid=IwAR13BqhmGe7XsbAxjr1gTzlCtz-zwx4QOR2-sKe9KTFG-gd8RDWB3B70zWs. [Accessed on Nov 12, 2021].

Dobson S, Voyer S, Hubinette M, Regehr G. From the clinic to the community: the activities and abilities of effective health advocates. Acad Med. 2015 Feb; 90(2). Https://doi.org/10.1097/ACM.0000000000000588.

83: Farrer L, Marinetti C, Cavaco YK, Costongs C. Advocacy for health equity: a synthesis review. Milbank Q. 2015 Jun; 93(2): 392-437. Https://doi.org/hyyps://doi.org/10.1111/1468-0009.12112.

Li A, Ngana GS, Pavalagantharajah S, Varyvoda D, Jones IGR, Olagunju AT. A student-driven advocacy project to address the opioid crisis in Canada: implications for developing competency in health advocacy during medical training. Acad Psychiatry. 2021. Https://doi.org/10.1007/s40596-021-01556-2.

Talarico S, Zubairi M, Daneman D, Punnett A, Martimianaakis MAT. Fostering transformative learning in a social pediatrics research summer studentship. Acad Med. 2019 May; 94(5): 692-696. Https://doi.org/10.1097/ACM.00000000000002597.

Ng E, Hu T, McNaughton N, Martimianakis MAT. Transformative learning in an interprofessional student-run clinic: a qualitative study. J Interprof Care. 2021 Oct; 35(5): 701-709. Https://doi.org/10.1080/13561820.2020.1807480.




How to Cite

Tang V, van Buuren A, Martimianakis MA (Tina). Evolving discourses of COVID-19 and implications for medical education: a critical discourse analysis. Can. Med. Ed. J [Internet]. 2022 Jun. 2 [cited 2024 Jul. 21];13(6):6-18. Available from: https://journalhosting.ucalgary.ca/index.php/cmej/article/view/71675



Original Research